Assessment of Percutaneous Laparoscopic Ultrasonography-Guided Core Needle Biopsy for the Advanced Diagnosis of Unresectable Pancreatic Cancer

  • Kosei Maemura Department of Digestive Surgery, Kagoshima University. Sakuragaoka, Kagoshima, Japan
  • Hiroyuki Shinchi Graduate School of Health Sciences, Kagoshima University. Sakuragaoka, Kagoshima, Japan
  • Yuko Mataki Department of Digestive Surgery, Kagoshima University. Sakuragaoka, Kagoshima, Japan
  • Hiroshi Kurahara Department of Digestive Surgery, Kagoshima University. Sakuragaoka, Kagoshima, Japan
  • Satoshi Iino Department of Digestive Surgery, Kagoshima University. Sakuragaoka, Kagoshima, Japan
  • Masahiko Sakoda Department of Digestive Surgery, Kagoshima University. Sakuragaoka, Kagoshima, Japan
  • Shinichi Ueno Department of Clinical Oncology, Kagoshima University. Sakuragaoka, Kagoshima, Japan
  • Sonshin Takao Center for Biomedical Science and Swine Research, Kagoshima University. Sakuragaoka, Kagoshima, Japan
  • Shoji Natsugoe Department of Digestive Surgery, Kagoshima University. Sakuragaoka, Kagoshima, Japan
Keywords: Biopsy, Large-Core Needle, Pancreatic Neoplasms, Ultrasonography


Context Before the initiation of cytotoxic therapy for locally unresectable pancreatic cancer, staging laparoscopy is an important diagnostic method for both the detection of occult small lesions and the extraction of a tumor sample for advanced pathological examination using core needle biopsy (CNB) under laparoscopic ultrasonography (LUS) guidance. Objective This study aimed to evaluate the safety and usefulness of LUS-guided CNB in pancreatic cancer. Methods Consecutive patients with locally unresectable pancreatic cancer who underwent staging laparoscopy were retrospectively analyzed. LUS-guided CNB was performed percutaneously under a laparoscopic view. The clinical results of the LUS-guided CNB group and the non-LUS-guided CNB group were compared. Results Forty-eight patients who underwent staging laparoscopy by LUS-guided CNB or endoscopic ultrasound-guided fine needle aspiration were identified. LUS-guided CNB was performed in 25 patients. The mean tumor size in the LUS-guided CNB group was significantly larger than that in the non-LUS-guided CNB group. No significant difference was observed between the two groups in operating time or bleeding volume. The rates of malignancy diagnosis and histological classification subtyping were significantly higher in the LUS-guided CNB group. Histologically differentiated adenocarcinoma was identified in 15 patients using samples acquired by LUS-guided CNB. There was no uncontrollable bleeding or other complications, and a significant difference in the occurrence of peritoneal dissemination after laparoscopic examination was observed between the two groups. Conclusion LUS-guided CNB enables the safe acquisition of sufficient tissue volumes for certain pathological analyses required to determine treatment strategies for locally unresectable advanced pancreatic cancer.

Image: Laparoscopic ultrasonography-guided core needle biopsy.


Download data is not yet available.


Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010; 60:277-300.[PMID: 20610543]

Stefanidis D, Grove KD, Schwesinger WH, Thomas CR Jr. The current role of staging laparoscopy for adenocarcinoma of the pancreas: a review. Ann Oncol 2005; 17:189-99.[ PMID: 16236756]

John TG, Wright A, Allan PL, Redhead DN, Paterson-Brown S, Carter DC et al. Laparoscopy with laparoscopic ultrasonography in the TNM staging of pancreatic carcinoma. World J Surg 1999; 23:870-81.[ PMID: 10449813]

John TG, Greig JD, Carter DC, Garden OJ. Carcinoma of the pancreatic head and periampullary region. Tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg 1995; 221:156-64.[ PMID: 7857143]

Thomson BN, Parks RW, Redhead DN, Welsh FK, Madhavan KK, Wigmore SJ et al. Refining the role of laparoscopy and laparoscopic ultrasound in the staging of presumed pancreatic head and ampullary tumours. Br J Cancer 2006; 94:213-17.[ PMID: 16434983]

Funel N, Giovannetti E, Del Chiaro M, Mey V, Pollina LE, Nannizzi S et al. Laser microdissection and primary cell cultures improve pharmacogenetic analysis in pancreatic adenocarcinoma. Lab Invest 2008; 88:773-84.[ PMID: 18490900]

Giovannetti E, Funel N, Peters GJ, Del Chiaro M, Erozenci LA, Vasile E et al. MicroRNA-21 in pancreatic cancer: correlation with clinical outcome and pharmacologic aspects underlying its role in the modulation of gemcitabine activity. Cancer Res 2010; 70:4528-38.[ PMID: 20460539]

Kliment M, Urban O, Cegan M, Fojtik P, Falt P, Dvorackova J et al. Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: the utility and impact on management of patients. Scand J Gastroenterol 2010; 45:1372-79.[ PMID: 20626304]

Goldin SB, Bradner MW, Zervos EE, Rosemurgy AS 2nd. Assessment of pancreatic neoplasms: review of biopsy techniques. J Gastrointest Surg 2007; 11:783-90.[ PMID: 17562121]

Jani N, Dewitt J, Eloubeidi M, Varadarajulu S, Appalaneni V, Hoffman B et al. Endoscopic ultrasound-guided fine-needle aspiration for diagnosis of solid pseudopapillary tumors of the pancreas: a multicenter experience. Endoscopy 2008; 40:200-3.[ PMID: 18067066]

de la Fuente SG, Ceppa EP, Reddy SK, Clary BM, Tyler DS, Pappas TN. Incidence of benign disease in patients that underwent resection for presumed pancreatic cancer diagnosed by endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA). J Gastrointest Surg 2010; 14:1139-42.[ PMID: 20424928]

Detlefsen S, Mohr Drewes A, Vyberg M, Klöppel G. Diagnosis of autoimmune pancreatitis by core needle biopsy: application of six microscopic criteria. Virchows Arch 2009; 454:531-9.[ PMID: 19238431]

Paulsen SD, Nghiem HV, Negussie E, Higgins EJ, Caoili EM, Francis IR. Evaluation of imaging-guided core biopsy of pancreatic masses. AJR Am J Roentgenol 2006: 187:769-72.[ PMID: 16928943]

Kim TH, Choi KH, Song HS, Kim JW, Jeon BJ. Histology combined with cytology by endoscopic ultrasound-guided fine needle aspiration for the diagnosis of solid pancreatic mass and intra-abdominal lymphadenopathy. Gut Liver. 2013;7:605-10.[ PMID: 24073320]

Xu K, Zhou L, Liang B, Niu L, Zheng X, Xu J et al. Safety and accuracy of percutaneous core needle biopsy in examining pancreatic neoplasms. Pancreas. 2012 ;41:649-51. [ PMID: 22504382]

Micames C, Jowell PS, White R, Paulson E, Nelson R, Morse M et al. Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA. Gastrointest Endosc. 2003 ;58:690-5.[ PMID: 14595302]

Shoup M, Winston C, Brennan MF, Bassman D, Conlon KC. Is there a role for staging laparoscopy in patients with locally advanced, unresectable pancreatic adenocarcinoma? J Gastrointest Surg 2004; 8:1068-71.[ PMID: 15585395]

Morak MJ, Hermans JJ, Smeenk HG, Renders WM, Nuyttens JJ, Kazemier G et al. Staging for locally advanced pancreatic cancer. Eur J Surg Oncol 2009; 35:963-8.

Liu RC, Traverso LW. Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by computed tomography. Surg Endosc 2005; 19:638-42.[ PMID: 15776215]

Maemura K, Shinchi H, Mataki Y, Kurahara H, Hayashi T, Kuwahata T et al. Advanced staging laparoscopy using single-incision approach for unresectable pancreatic cancer. Surg Laparosc Endosc Percutan Tech. 2011;21:e301-5. [PMID: 22146176]

Jakimowicz JJ. Intraoperative ultrasonography in open and laparoscopic abdominal surgery: an overview. Surg Endosc 2006; 20:S425-35. [PMID: 16544064]

Strasberg SM, Middleton WD, Teefey SA, McNevin MS, Drebin JA. Management of diagnostic dilemmas of the pancreas by ultrasonographically guided laparoscopic biopsy. Surgery 1999; 126:736-41; discussion 741-3.[ PMID: 10520923]

Bang JY, Hebert-Magee S, Trevino J, Ramesh J, Varadarajulu S. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc. 2012;76:321-7.[PubMed PMID:22658389]

Schoellnast H, Komatz G, Bisail H, Talakic E, Fauster M, Ehammer T et al. CT-guided biopsy of lesions of the lung, liver, pancreas or of enlarged lymph nodes: value of additional fine needle aspiration (FNA) to core needle biopsy (CNB) in an offsite pathologist setting. 2010;17:1275-81. [PMID: 20621527]

Gleeson FC, Kipp BR, Caudill JL, Clain JE, Clayton AC, Halling KC et al. False positive endoscopic ultrasound fine needle aspiration cytology: incidence and risk factors. Gut 2010; 59:586-93.[ PMID: 20427392]

Butturini G, Crippa S, Bassi C, Salvia R, Piccoli M, Pederzoli P. The role of laparoscopy in advanced pancreatic cancer diagnosis. Dig Surg 2007; 24:33-7.[ PMID: 17369679]

Stewart CJ, Coldewey J, Stewart IS. Comparison of fine needle aspiration cytology and needle core biopsy in the diagnosis of radiologically detected abdominal lesions. J Clin Pathol. 2002 ;55:93-7. [PMID: 11865001]

Ashida R, Nakata B, Shigekawa M, Mizuno N, Sawaki A, Hirakawa K et al. Gemcitabine sensitivity-related mRNA expression in endoscopic ultrasound-guided fine-needle aspiration biopsy of unresectable pancreatic cancer. J Exp Clin Cancer Res 2009; 28:83 DOI: 10.1186/1756-9966-28-83.[ PMID: 19531250]

Laurell H, Bouisson M, Berthelemy P, Rochaix P, Dejean S, Besse P et al. Identification of biomarkers of human pancreatic adenocarcinomas by expression profiling and validation with gene expression analysis in endoscopic ultrasound-guided fine needle aspiration samples. World J Gastroenterol 2006; 12:3344-51.[ PMID: 16733850]

Leung TH, Ngan HY. Interaction of TAp73 and breast cancer-associated gene 3 enhances the sensitivity of cervical cancer cells in response to irradiation-induced apoptosis. Cancer Res 2010; 70:6486-96.[ PMID: 20647320]

Yu G, Zhu MH, Zhu Z, Ni CR, Zheng JM, Li FM. Expression of ATM protein and its relationship with p53 in pancreatic carcinoma with tissue array. Pancreas 2004; 28:421-6.[ PMID: 15097860]

Huguet F, Mukherjee S, Javle M. Locally advanced pancreatic cancer: the role of definitive chemoradiotherapy. Clin Oncol (R Coll Radiol). 2014; 26:560-68. [PMID:25001636]

He J, Page AJ, Weiss M, Wolfgang CL, Herman JM, Pawlik TM. Management of borderline and locally advanced pancreatic cancer: where do we stand? World J Gastroenterol. 2014 ;20:2255-66. [PMID: 24605025]

Laparoscopic ultrasonography-guided core needle biopsy
How to Cite
MaemuraK., ShinchiH., MatakiY., KuraharaH., IinoS., SakodaM., UenoS., TakaoS., & NatsugoeS. (2015). Assessment of Percutaneous Laparoscopic Ultrasonography-Guided Core Needle Biopsy for the Advanced Diagnosis of Unresectable Pancreatic Cancer. JOP. Journal of the Pancreas, 16(1), 45-49.